Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht 6200 MD, the Netherlands.
Radius Health, Inc., Waltham, MA, United States.
Semin Arthritis Rheum. 2019 Oct;49(2):184-196. doi: 10.1016/j.semarthrit.2019.01.006. Epub 2019 Jan 10.
There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared with teriparatide (TPTD) followed by ALN (TPTD/ALN).
A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective. Patients were assumed to receive ABL or TPTD for 18 months followed by 5 years of ALN in line with clinical recommendations. The effects of ABL on fracture risk were derived from the ACTIVExtend trial. The effects of TPTD were assumed to be maintained during subsequent ALN treatment, consistent with ACTIVExtend findings for ABL. Evaluation was completed for patients, aged 50-80 years with a BMD T-score ≤ -3.5 or with a T-score between -2.5 and -3.5 and a history of ≥ one osteoporotic fracture.
In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, higher QALYs) compared with sequential TPTD/ALN therapy, resulting from the improved efficacy and lower drug price of ABL. Probabilistic sensitivity analyses suggested that ABL/ALN was dominant in at least 99% of the simulations. Compared to no treatment, the cost per QALY gained of ABL/ALN was always below $130,000.
Sequential ABL/ALN therapy is a cost-effective (dominant) strategy compared with sequential TPTD/ALN therapy for the treatment of US women at increased risk of fractures.
越来越多的证据支持对高脆性骨折风险患者采用骨合成药物序贯抗吸收药物治疗。本研究评估了阿巴洛肽（ABL）序贯治疗后接着用阿仑膦酸钠（ALN）（ABL/ALN）与特立帕肽（TPTD）序贯治疗后接着用 ALN（TPTD/ALN）相比的成本效果。
本研究从美国支付方角度，利用之前验证过的 Markov 微型模拟模型来估计 ABL/ALN 序贯治疗相对于 TPTD/ALN 序贯治疗和不治疗的成本效果，时间范围为终生。假设患者按照临床建议接受 ABL 或 TPTD 治疗 18 个月，然后再接受 5 年的 ALN 治疗。ABL 对骨折风险的影响来自 ACTIVExtend 试验。TPTD 的影响假设在后续 ALN 治疗期间保持不变，与 ACTIVExtend 对 ABL 的研究结果一致。评估对象为年龄在 50-80 岁之间、骨密度 T 评分≤-3.5 或 T 评分在-2.5 至-3.5 之间且有≥1 次骨质疏松性骨折史的患者。
在所有模拟人群中，ABL/ALN 序贯治疗均优于 TPTD/ALN 序贯治疗（成本更低，QALY 更高），这归因于 ABL 的疗效改善和药物价格降低。概率敏感性分析表明，在至少 99%的模拟中，ABL/ALN 是主导治疗。与不治疗相比，ABL/ALN 的每增加一个 QALY 的成本始终低于 130000 美元。
与 TPTD/ALN 序贯治疗相比，ABL/ALN 序贯治疗是一种具有成本效果（主导）的策略，可用于治疗美国骨折风险增加的女性患者。
